PROJECT SUMMARY/ABSTRACT Since 2002, the NIDDK has sponsored Phases 1-3 of the prospective Chronic Renal Insufficiency Cohort (CRIC) Study, which enrolled a combined cohort of >5400 adults with chronic kidney disease (CKD) at seven Clinical Centers to address the overarching goals of identifying risk factors for CKD progression and clarifying the relationship between kidney dysfunction and the risks of subclinical and clinical cardiovascular events, death, resource utilization and other patient-centered outcomes through June 2018. The proposed CRIC 2018- 2023 will leverage the existing efforts and success of the CRIC Study network by extending the follow-up for the existing cohort and expanding into novel areas focused on more granular investigation of kidney function trajectories and cardiovascular sub-phenotyping, among others. CRIC 2018-2023 will become an unparalleled resource for the broader community that will enhance the science related to CKD to achieve the ultimate goal of improving clinical and patient-centered outcomes. Specific Aims to be addressed by the Kaiser Permanente Northern California/University of California, San Francisco Clinical Center are: 1. To re-enroll a high percentage of existing participants 2. To maintain high levels of participant retention 3. To collect exposure and outcome data, including remotely collected kidney function, cardiovascular function, questionnaires, physical measurements and specimens 4. To investigate and adjudicate cardiovascular and renal events 5. To enter data and process/ship biological specimens 6. To implement effective local quality assurance and quality control procedures 7. To monitor regularly data collection, data entry, and follow-up procedures 8. To participate in governance and oversight of CRIC 9. To publish and present findings from the CRIC Study, including integrative and other high-impact manuscripts 10. To conduct CRIC ancillary studies 11. To engage investigators at the Clinical Center to assist in the local analysis of CRIC data, to develop and conduct ancillary studies, and to participate in parent study activities 12. To engage investigators in the broader scientific community to analyze data locally, to develop and conduct ancillary studies, and to participate in the parent study